Interactive Medicare Electronic Remittance Advice (ERA)
The Medicare Electronic Remittance Advice (ERA) is a notice sent to home health and hospice providers explaining how billing transactions are processed (paid, rejected, or denied). Billing transactions include final claims, adjustments, and canceled, denied, or rejected claims, as well as Requests for Anticipated Payments (RAPs). Medicare provides the PC-Print software for provider to view and print the ERA. Other software is available; however, the following information represents the view of the ERA using the PC-Print software. Providers are also able to view and print Medicare remittances using myCGS (the CGS Web portal).
This interactive guide provides an overview of the ERA using PC-Print. Select the screen option (below) that you wish to view. As you move your mouse over the area of interest, the field(s) will highlight. Click on the area of interest to view more detailed information.
PC-Print offers four different options to display and print data.
- All Claims (AC) screen provides information for multiple billing transactions at once. The AC screen will list billing transactions in alphabetical order by the beneficiary's last name.
- Single Claim (SC) screen provides a detailed summary of a single billing transaction. An SC screen is available for each billing transaction listed on the AC screen.
- Bill Type Summary (BS) screen provides a summary of billing transactions for each type of bill and for each fiscal year (FY) based on the billing transactions included in the ERA. For example, if there are home health claims processed with the type of bill 33X for FY18 and FY19, two separate bill type summary screens will be provided. One screen will display the FY18 claims and the other will display a summary of the FY19 claims.
- Provider Payment Summary (PS) screen provides a summary of the payments made to billing transactions included in the ERA. In addition, this screen will show financial adjustment information, only if financial adjustments are made. For additional information, refer to the "Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)" article. For a complete list of Provider Level Adjustment Reason Codes, refer to the ASC X12N 835 Implementation Guide: Health Care Claim Payment/Advice available on the Washington Publishing Company website.
All Claims (AC) Screen
The All Claims (AC) screen provides information for multiple billing transactions at once. The AC screen will list billing transactions in alphabetical order by the beneficiary's last name.
As you move your mouse over the area of interest, the field(s) will highlight and the name of the field and more detailed information will display.
Single Claim (SC) Screen
The Single Claim (SC) screen provides a detailed summary of a single billing transaction. An SC screen is available for each billing transaction listed on the AC screen.
As you move your mouse over the area of interest, the field(s) will highlight and the name of the field and more detailed information will display.
FPEThe provider Fiscal Period End (FPE). |
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PAIDThe date of the remittance advice. |
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CLM#The claim number assigned by the PC-Print software to each billing transaction printed on the remittance advice. |
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NPIThe National Provider Identifier (NPI) of the facility receiving the remittance advice. |
TOBThe Type of Bill (TOB) of the billing transaction (e.g., final claim, adjustment, canceled, denied, or rejected claim, and Request for Anticipated Payment (RAP).) |
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PATIENTLast name, first name (or first initial) and middle initial (if available) of the beneficiary for whom the billing transaction was processed. |
PCNPatient control number that was submitted on the billing transaction. |
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MIDBeneficiary’s Medicare ID number for whom the billing transaction was processed. |
SVC FROMThe start date of services on the processed billing transaction. |
MRNThe medical record number that was submitted on the billing transaction. |
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CLAIM STATThe status of the billing transaction when it completed processing. The following codes are used by Medicare.
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THRUThe last date of services on the processed billing transaction. |
ICNInternal Control Number (ICN), also referred to as the Document Control Number (DCN) is a unique number assigned to the billing transaction when received by CGS. |
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REIM RATEThe per diem amount or percentage of reimbursement paid to a provider, depending on how the provider is reimbursed for an individual claim. Not applicable to home health and hospice billing transactions. |
COINSURANCEThe dollar amount of coinsurance for which the beneficiary is responsible. |
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REPORTEDThe dollar amount of charges submitted by the provider or that are covered by Medicare. For cancel billing transactions (type of bill XX8) and home health requests for anticipated payment (RAPs), this amount is negative. |
HHA SN AMTThe dollar amount paid on a per visit basis for skilled nursing visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher. |
MSP PRIM PAYERThe amount that the primary insurance paid for the services on the billing transaction. |
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NCVD/DENIEDThe dollar amount of non-covered or denied charges. |
HHA PT AMTThe dollar amount paid on a per visit basis for physical therapy visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher. |
CASH DEDUCTThe dollar amount applied to the beneficiary’s deductible. |
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CLAIM ADJSThe claim level adjustment, such as a home health outlier payment. |
HHA ST AMTThe dollar amount paid on a per visit basis for speech-language pathology visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher. |
PAT REFUNDThe dollar amount the provider owes the beneficiary for overpaid deductible and coinsurance. |
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LINE ADJ AMTThe total of line item adjusted amounts. |
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COVEREDThe dollar amount of covered charges. If all services/visits are covered, this amount is the same as the amount in the REPORTED field. |
HHA OT AMTThe dollar amount paid on a per visit basis for occupational therapy visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher. |
PROC CD AMOUNTThe procedure code amount for billing transactions. Not applicable to home health and hospice billing transactions. |
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HHA MS AMTThe dollar amount paid on a per visit basis for medical social worker visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher. |
ALLOW/REIMThe allowable reimbursement amount that the provider receives for the covered services. |
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COST REPTThe number of days used and applied to the Medicare Cost Report (MCR). This field does not apply to home health requests for anticipated payment (RAP) and hospice billing transactions. |
HHA NA AMTThe dollar amount paid on a per visit basis for nurses aide visits (i.e., LUPA). This field will display zeros for claims paid under the Home Health Prospective Payment System (HH PPS). This field is unique to PC Print version 2.01 or higher. |
SEQUESTRAINThe 2 percent payment reduction on billing transactions with dates of service on or after April 1, 2013. The RC field on the remittance will include the Claim Adjustment Reason Codes (CARCs) 253 to explain the adjustment in payment. |
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COVD/UTILThe number of covered days or visits. For home health requests for anticipated payment (RAPs), this field displays a zero. For home health final claims, this field displays the number of covered visits. |
HSP ROUT CAREThe reimbursement amount for covered hospice routine home care units. This field is unique to PC Print version 2.01 or higher. |
INTERESTThe dollar amount of interest paid by Medicare. Interest is paid on clean billing transactions that are not paid within the 30-day timeframe. |
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NON-COVEREDThe number of non-covered days or visits. |
HSP CONT CAREThe reimbursement amount for covered hospice continuous home care units. This field is unique to PC Print version 2.01 or higher. |
CONTRACT ADJAn adjustment resulting from a contractual agreement between the payer and payee. |
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COVD VISITSThe number of covered visits. |
HSP GENERALThe reimbursement amount for covered hospice general inpatient care units. This field is unique to PC Print version 2.01 or higher. |
PBP REDUCTPopulation Based Payments (PBP) – Applies when provider agrees to participate in the Next Generation Accountable Care Organizations (ACO) Model. |
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NCOV VISITSThe number of non-covered visits. For home health, this field displays the number of visits denied by medical review. |
HSP RESPITEThe reimbursement amount for covered hospice respite care units. This field is unique to PC Print version 2.01 or higher. |
PA REDUCTPennsylvania Rural Health Model (only applies to rural Pennsylvania hospitals). |
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HSP PHYS SVCThe reimbursement amount for covered hospice physician services. This field is unique to PC Print version 2.01 or higher. |
NET REIM AMTThe net reimbursement amount received for this billing transaction. |
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HSP OTHThe reimbursement amount for other covered hospice units. This field is unique to PC Print version 2.01 or higher. |
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REMARK CODESRemittance Advice Remark Codes (RARCs) that relay informational messages. A list of the latest codes is available at: http://www.wpc-edi.com/reference/codelists/healthcare/remittance-advice-remark-codes/. |
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REVThe specific revenue code for the individual service line. |
DATEThis field indicates the date of service (MM/DD). |
HCPCSThis field indicates the Healthcare Common Procedure Coding System (HCPCS) code, if applicable. |
APC/HIPPSThis field indicates the Ambulatory Payment Classification (APC) and/or Health Insurance Prospective Payment System (HIPPS) code, if applicable. |
MODSThis field displays modifiers for the individual service line, if applicable. |
QTYThe number indicating how many services were billed per revenue code. |
CHARGESThe billed amount for each individual service line. |
ALLOW/REIMThe allowed amount or reimbursement amount for the individual service line, if applicable. |
GCThe Group Code which identifies the financially responsible party or the general category of payment adjustment. A Claim Adjustment Reason Code (CARC) must accompany group codes. For additional information, refer to the Medicare Claims Processing Manual, Chapter 22, Section 130.1 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c22.pdf. |
RSNThe Claim Adjustment Reason Code (CARC) for the individual service line, if applicable. A full list of CARCs may be found at http://www.wpc-edi.com/reference/ on the Washington Publishing Company (WPC) website. |
AMOUNTThe amount of any adjustment to what was billed. |
REMARK CODESThe Remittance Advice Remark Codes (RARCs) for the individual service line, if applicable. A full list of CARCs may be found at http://www.wpc-edi.com/reference/ on the Washington Publishing Company (WPC) website. |
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LICNLine item control number. |
HCPIHealthcare Policy Identification. |
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SVC DescService payment information. |
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Bill Type Summary (BS) Screen
The Bill Type Summary (BS) screen provides a summary of billing transactions for each type of bill and for each fiscal year (FY) based on the billing transactions included in the ERA. For example, if there are home health claims processed with the type of bill 33X for FY13 and FY14, two separate bill type summary screens will be provided. One screen will display the FY13 claims and the other will display a summary of the FY14 claims.
As you move your mouse over the area of interest, the field(s) will highlight and the name of the field and more detailed information will display.
FPEThe provider Fiscal Period End (FPE). |
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PAIDThe date of the remittance advice. |
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CLM#The number of claims for which the BS contains data. |
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NPIThe National Provider Identifier (NPI) of the facility receiving the remittance advice. |
TOBThe Type of Bill (TOB) of the billing transaction (e.g., final claim, adjustment, canceled, denied, or rejected claim, and Request for Anticipated Payment (RAP).) |
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CHECK / EFT NUMBERThe check or Electronic Funds Transfer (EFT) transaction number through which payment was issued. |
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REIM RATEThe overall per diem amount or percentage of reimbursement paid to a provider, depending on how the provider is reimbursed for an individual claim. Not applicable to home health and hospice billing transactions. |
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REPORTEDThe total dollar amount of charges on this ERA that were submitted by the provider with the type of bill shown in the TOB field. |
DRG AMOUNTThe total Diagnostic Related Group (DRG) amount. Not applicable to home health and hospice billing transactions. |
MSP PRIM PAYERThe total amount that the primary insurance paid for claims with this type of bill. |
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NCVD/DENIEDThe total dollar amount of non-covered or denied charges for billing transactions on this ERA with the type of bill shown in the TOB field. |
DRG/OPER/CAPThe total operating and capital Diagnostic Related Group (DRG) amount. Not applicable to home health and hospice billing transactions. |
PROF COMPONENTThe total professional component amount for this type of bill. |
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CLAIM ADJSThe total dollar amount of claim level adjustment, such as a home health outlier payment, for billing transactions on this ERA with the type of bill shown in the TOB field. |
LINE ADJ AMTThe total line adjustment amount for this type of bill. This amount is determined by totaling the amounts in the LINE ADJ AMT field on the All Claims (AC) screen for claims with this type of bill. |
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COVEREDThe total dollar amount of covered charges for billing transactions on this ERA with the type of bill shown in the TOB field. This amount is the sum of the amounts shown in the COVD CHRGS field on the All Claims (AC) report with this type of bill. |
OUTLIERThe total outlier amount paid for this type of bill. This field is the sum of the outlier amounts shown in the CLAIM ADJS field on the All Claims (AC) screen. Only applicable to home health billing transactions. |
PROC CD AMOUNTThe total procedure code amount for this type of bill. Not applicable to hospice billing transactions. |
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CAP OUTLIERThe total outlier portions of Prospective Payment System (PPS) payments for capital. An amount shows in this field when an outlier was paid on one or more of the billing transactions processed on this ERA. Only applicable to home health billing transactions. |
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COST REPTThe number of days used and applied to the Medicare Cost Report (MCR). This field does not apply to home health requests for anticipated payment (RAP) and hospice billing transactions. |
CASH DEDUCTThe total cash deductible amount for this type of bill. This amount is the sum of the amounts in the DEDUCTIBLES field on the All Claims (AC) screen. Applicable to home health outpatient therapy claims (34X type of bill). |
PBP REDUCTPopulation Based Payments (PBP) – Applies when provider agrees to participate in the Next Generation Accountable Care Organizations (ACO) Model. |
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COVD/UTILThe number of covered days or visits. For home health requests for anticipated payment (RAPs), this field displays a zero. For home health final claims, this field displays the number of covered visits. |
BLOOD DEDUCTThe total number of pints of blood applied to the beneficiary’s blood deductible. Not applicable to home health and hospice billing transactions. |
INTERESTThe total amount of interest paid by Medicare for this type of bill. Interest is paid on clean billing transactions that are not paid within the 30-day timeframe. |
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NON-COVEREDThe number of non-covered days or visits. |
COINSURANCEThe total coinsurance amount for this type of bill. This amount is the sum of the amounts shown in the COINS AMT field on the All Claims (AC) screen. |
CONTRACT ADJThe total contractual adjustment amount. This amount is the sum of the amounts in the CONT ADJ AMT field on the All Claim (AC) screen for this type of bill. |
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COVD VISITSThe number of covered visits. |
PAT REFUNDThe total beneficiary refund amount for this type of bill. This amount is the sum of the amounts shown in the PAT REFUND field on the All Claims (AC) screen. |
PER DIEM AMTThe total per diem for this type of bill. Not applicable to hospice billing transactions. |
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NCOV VISITSThe number of non-covered visits. For home health, this field displays the number of visits denied by medical review. |
SEQUESTRATNThe 2 percent payment reduction on billing transactions with dates of service on or after April 1, 2013. The RC field on the remittance will include the Claim Adjustment Reason Codes (CARCs) 253 to explain the adjustment in payment. |
PA REDUCTPennsylvania Rural Health Model (only applies to rural Pennsylvania hospitals). |
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NET REIM AMTThe total net reimbursement amount for this type of bill. This amount is the total of amounts in the NET REIMB field on the All Claims (AC) screen for this type of bill. |
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Provider Payment Summary (PS) Screen
The Provider Payment Summary (PS) screen provides a summary of the payments made to billing transactions included in the ERA. In addition, this screen will show financial adjustments information, only if financial adjustments have been made. For additional information, refer to the "Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)" article.
As you move your mouse over the area of interest, the field(s) will highlight and the name of the field and more detailed information will display.
NPIThe National Provider Identifier (NPI) of the facility receiving the remittance advice. |
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CHECK / EFT NUMBERThe check or electronic funds transfer number. |
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PAYMENT TOTALThe net reimbursement for the billing transactions processed on this remittance advice. |
BILLING CYCLEThe date that the billing transactions on this remittance advice were paid. |
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TOTAL CLAIMSThe total number of billing transactions included on this remittance advice. |
TOTAL PIP CLAIMSThe total number of billing transactions processed under the Periodic Interim Payment (PIP). Not applicable to home health and hospice providers. |
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FINANCIAL ADJUSTMENTSFinancial Adjustments will only display when financial adjustments have been made. For additional information, refer to the “Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)” article. |
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Payer Business Contact InformationTelephone Payer Technical Contact InformationTelephone Extension The business and technical contact information for CGS. |
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Updated: 10.15.20